A U- or J-shaped curve for the relation of alcohol consumption to cardiovascular disease (CVD) among diabetics has been shown in most prospective epidemiologic studies for many years, and CVD is the leading cause of death among diabetics. A variety of potential mechanisms of protection against CVD have been described, including beneficial effects of moderate drinking on lipids, inflammatory markers, and insulin resistance. The current paper assesses the effects of alcohol use among participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. It was based on more than 11,000 subjects with diabetes from 20 countries, including those in Eastern Europe, Asia, and established market economies in Western Europe, North America, and the Pacific region. The outcomes over 5 years of follow up were CVD events (death from CVD, non-fatal myocardial infarction, non-fatal stroke), microvascular disease (renal disease, diabetic eye disease), and all-cause mortality.
Key results of the analyses showed that during follow up, more than 1,000 subjects (about 10%) had a major CVD, with similar percentages experiencing a microvascular complication or dying. The authors report that “Compared with abstainers, any alcohol use was associated with a 17% lower risk of cardiovascular events, a 15% lower risk of microvascular complications, and a 13% lower risk of all-cause mortality.” While there were few heavy drinkers (<4% of subjects), their data indicated that there was no significant lowering of risk of the outcomes among such subjects. Subjects who consumed wine had lower estimates of cardiovascular disease outcomes and mortality than consumers of other beverages.
Forum reviewers considered this to be a well-done analysis based on a large cohort of subjects with diabetes mellitus, with an adequate number of non-drinkers to serve as a referent group. The results strongly support previous studies that have shown a lower risk of cardiovascular events and total mortality among diabetic subjects who consume moderate alcohol. The study also showed that the risks of microvascular complications (diabetic kidney disease, diabetic eye disease) were lower among moderate drinkers.
The Forum considers this to be an important message (to physicians and the public), as the vascular ravages of diabetes are very serious, and diabetes is such a common disease that is increasing throughout the world. Diabetic patients without contraindications to alcohol sorely need to know of the potential cardiovascular protection of moderate alcohol consumption.
Reference: Blomster JI, Zoungas S, Chalmers J, Li Q, Chow CK, Woodward M, Mancia G, Poulter N, Williams B, Harrap S, Neal B, Patel A, Hillis GS. The relationship between alcohol consumption and vascular complications and mortality in individuals with type 2 diabetes mellitus. Diabetes Care 2014; pre-publication: DOI: 10.2337/dc13-2727
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